Thank you. I often say I wish I could take people back in to the hospitals in the early days of Covid. It was terrifying. We had no idea what to expect. The rules were changing daily. No PPE. Freezer trucks full of bodies. To see people attack Dr. Fauci enrages me. They have no idea what we were dealing with. Thank God for scientists like him, like you, who were giving us some guidance.
Bring Musk back into the hospital and let him eat cake from the floor. What a disgusting quote and propaganda poster. What a dangerous person and general backlash against all of us for whom they once banged pots and pans at 7PM, rallying our spirits to keep taking care of the sick and dying while putting ourselves in harm’s way.
We have the answers to the questions posed in this article already. It’s just a matter of who gets to answer them… those demagogues with ulterior motives, or us on the front lines serving who could easily walk away, save for our integrity and calling.
The pundits and deniers have not considered the fact that, had we not respected science, we'd still have children dying from the measles, crippled from polio and marred by small pox. The delivery of multiple vaccines that miraculously and dramatically reduced the rate of death, ICU admission, mechanical ventilation and hospital admission within a short 12 months of outbreak of the COVID virus is a true miracle of modern science, but the pundits and deniers haven't acknowledged that. Even with the vaccine widely available, it took months and months to reach vaccination levels between 60-70% of the eligible population. If you're not an expert yourself and people are dying all around you, why would you possibly choose to deny that professionals with lifelong dedication to fighting disease know less than you about public health measures and the efficacy of vaccines? It defies even first-grade logic.
It's so hard to believe this was only 4 years ago. You would think it was so long ago that few people have a living memory of it the way some people are second guessing - not in a productive, but in a destructive way - everything that was done
Decisions were made with the information on hand at the time, and constantly evolving as information was updated. Hindsight always seems to be 20/20 but if not for Dr. Fauci and the other scientists, the situation could've been even worse than it already was. Thank you for being here and writing this newsletter to keep us all better informed.
You don’t think there would have been more spread of Covid if we had been standing shoulder to shoulder?
The virus is aerosolized, but is also spread by droplets. Reducing one kind if exposure doesn’t eliminate the entire risk, but it probably helps. Of each of the mitigation steps, 6 foot distancing seems like one of the easiest.
There's no way the virus could spread so rapidly and broadly if it wasn't almost entirely spread by aerosols. We were never going to be able to suppress this virus. That was clear at the beginning to anyone thinking critically who was not blinded by hubris
Can you repeat your points while thinking critically and while not being blinded by hubris?? The FACT is that infection is the product of level of exposure X length of that exposure. So every foot of distance that reduces the concentration of an airborn pathogen and every minute that reduces the length of that exposure is critical. THAT is CRITICAL thinking and done without hubris! So, yes, 6 ft separation helps!!
Please tell us what you would’ve done Paul. You’re so quick to call BS, to point fingers at the ones who stood up and tried to contain this sh*t-storm but what would YOU have done? Nothing?, no shutdown? No distancing? Why not, let’s not wash our hands… Right! That would’ve been fun to watch the entire health care system crumble. You criticize yet offer no solutions… let’s all put you in charge of the next pandemic.🙄
For starters, I wouldn't have created mass hysteria. Hysteria is extremely dangerous - the media and politicians ran with the fear porn and the rest is history. The data from the Diamond Princess cruise ship told us everything we needed to know, really. The virus was airborne and very contagious, but presented as fairly mild respiratory illness for the vast majority of the population. Older people with co-morbidities are most at risk.
This is essentially what Fauci said in the New England Journal of Medicine on Feb. 28 - this virus is akin to a severe seasonal influenza with IFR well below 1% (it's actually below 0.1% for most of the population)
I also would have been honest with people and told them that the virus was almost certainly spreading here well before we started testing for it in the United States. And the idea that China "discovered" it in Dec 2019 is silly - it was spreading well before then.
If it WAS akin to a severe seasonal influenza (BEFORE it evolved…), please explain how it is that an entire hospital department of 30 patients AND an entire ICU filled up with COVID patients needing respiratory assitance (and on ventilators in the ICU)… ALL with COVID infections… Right here your reasoning is wrong. You should reassess your thinking about all this!
TFG fired the Pandemic Response Team in 2018. Simply because Obama created it. We know who the bad actors were. The problem is that too many people listened to the conspiracy theories, and were already brainwashed not to follow the rules of public health and safety, for decades. The anti-vaxxer/science movement of the past decade plus didn't help and neither did social media platforms that still allow disinformation and misinformation to flow freely on their platforms with no recourse for those that constantly report it to no avail.
You have perfectly expressed exactly what I feel. I live in a deep red rural area of SW Michigan where "Proudly unvaccinated!" was a battle cry against big government control. No problem, though: these neighbors didn't need vaccines because they had Jesus. Needless to say, I stayed home a lot.
Dr. Jetelina, as a retired physician I read your column regularly, and I thank you sincerely for your well-researched, balanced and clear information. Recently a report was published in BMJ re: Pandemic excess deaths. It implies that basically all the mitigating measures, including vaccines, appeared to have no effect on excess deaths. The authors did list many limitations of the study, and clearly these are numbers without a lot of specificity. But it is already being cited by anti-vax, far-right conspiracy theorists as proof that Covid vaccines and other mitigating behaviors do no good. If you could address this in a column it would be great - Thank you again. https://bmjpublichealth.bmj.com/content/2/1/e000282
Vaccines were hoped to prevent transmission, but more importantly, they were hoped to to reduce severe disease. They achieved the first for a few months, and have achieved the second since they were introduced.
We should remember that the measures to “slow the curve” in spring 2020 really did “slow the curve.” Did it stop the pandemic? No. Did it let hospitals catch up and be more ready to help the thousands sick? Yes.
the measures to “slow the curve” in spring 2020 really did “slow the curve.”
There's no evidence to support this, though. Spring waves of respiratory viruses come and go every year without us implementing "measures" It's incredibly arrogant to think we have control over these phenomena.
As far as the vaccines go, be honest with the public from the start. Say "we hope" instead of "we know". Don't mandate and coerce and publicly shame.
Oh, please...a world-wide immunologically naive population, many millions of tiny children, adults living with co-morbid risks and a rising worldwide elderly population was a ticket for mass casualties, which actually occurred. You can't compare this to the average flu season. Only now, with broad vaccination, broad population exposure rendering a degree of herd immunity can COVID be considered endemic as opposed to epidemic, and there are still places on earth where essentially no-one has been vaccinated. Show me a common cold virus or influenza that produces Long COVID. Would you really like to return to a world without smallpox, polio, influenza, rubella, measles, mumps protection? Perhaps you weren't alive before there was protection from these? In 1918-19, an unvaccinated world lost millions of lives to the "spanish flu". Now, after we've experienced another (hopefully) once in a lifetime pandemic, the pundits and deniers are already out in force. Unbelieveable...
So if what you are saying "vax and social distancing" didn't help, why were fatalities (and exceeds deaths), LESS than half of US deaths? Canada has a higher vax rate than the US, and best I can tell from my travels took social distancing guidelines more seriously than in the US
Hospitals were not overwhelmed Spring 2020, there was nothing to catch up to. That is a Mandela Effect or something, you are misremembering history.
We pre-emptively halted elective medicine, anticipating a surge that never came.
It's possible (I would argue likely) that this decision had the unintended effect of lowering staffed beds by 20% which persists today unfortunately (we were at roughly 920K beds nationwide pre March 2020, been hovering 700+ since then IIRC). It's a very complex cascade of events that lead to this point.
Countries which did much less, reopened schools, didn't halt elective medicine, had brief lockdowns, etc fared better.
Yes! I had not seen her video, and will watch the whole thing today. When I read the article I realized that quite possibly the very *limitations* the authors admitted to might be the key to the whole mystery of why the numbers seem to imply ineffectiveness of anti-Covid measures. Thank you for sharing the video link.
You don't need to be "far right" or "anti vax" to see that mortality figures do not support the mitigation hypothesis. I haven't read the linked paper, but it is true that mortality largely increased following rollout of vaccines in many, many countries including South Korea, Germany, Australia, Finland, Denmark, Canada, Taiwan, etc.
It is also true many countries saw no change in excess mortality following vaccination including the US, Portugal, Netherlands, Austria and Israel.
And it's also true many countries did see some decrease in all cause mortality including Italy, Sweden, and Belgium. Others saw a "dead cat bounce" like France and Spain.
Of these examples, what happened in South Korea in 2022 I believes deserves the most scrutiny. The country praised for "doing it right" had one of the largest increases in all cause mortality of *any* country in the world, *after* they were fully vaccinated and *while* still wearing masks (behaviors didn't change either - back in school spring 2020, lockdowns lifted, etc).
On the other hand, why did countries like Bulgaria, which had very low vaccination rates, *not* pay any price in terms of all-cause mortality? They returned back to baseline by 2022. Why didn't Covid overwhelm Africa as predicted (remember how much concern there was on "equitable" access, now we are throwing out millions of doses Africa didn't use).
Presently, almost every country in the world now only recommends Covid vaccines in limited cohorts. Very few, even in those cohorts are taking them. Demand as plummeted, and despite claims from many in Public Health that this is a mistake and deaths will follow, all-cause mortality in 2023 in every country largely returned back to baseline.
You can be "pro vax" while acknowledging some vaccines don't work. Ralph Baric wasn't "anti vax" when admitting he didn't understand why the Covid vaccines he was testing on humanized mice made them sicker to other Covid strains. Michael Osterholm wasn't antivax when admitting scientists don't understand why flu vaccines often fail.
My biggest complaint the last four is that promoters of all of these extraordinary claims have constructed their arguments so they cannot be falsified.
No amount of counterfactuals make them alter their convictions, which is why it seems a lot of this was all pseudoscience after all.
Clean version of all-cause mortality for selected countries, if interested. Still need to get South Korea before I update to 2023:
I'm sorry but a google sheet without the actual link to the countries data does not count as proof. I'm on the ground and I see excess death from COVID and the many months of damage from COVID. Many unvaccinated persons have less antibodies than vaccinated when I test. Additionally, when unvaccinated persons microclot and are positive with fibrinogen activity and d dimer levels they do worse than vaccinated at this point. Anecdotally and epi wise, vaccinated fair much better even with acute covid and long covid. https://www.webmd.com/vaccines/covid-19-vaccine/news/20240221/vaccinated-people-lower-risk-long-covid-study
Where are you located? In the US excess deaths are back to near zero. Compare 1st 17 week average all-cause mortality of 2024 (60, 859) to 2019 (57,285) to 2015 (55,713). This is holding true for many countries.
The data set I put in google sheet pulled from mortality.org, which aggregates each country CDC reporting and then passes through to Our World in Data. If you trust the CDC or OWID, you are trusting that data set. You can create here:
I am not going to spend time assessing a study based on surveys, which are among the lowest tier of evidence.
Maybe that is true, maybe not. If it is true, we should expect to see Long Covid crippling the continent of Africa as well as countries like Bulgaria, Poland, Lebanon, Syria, Ukraine, etc. Quick google doesn't turn much up.
I’m located in an area where the lowest vaccination rate is 10% and the highest is 42%. Covid is kicking our community with complications of long Covid Ie. Heart attacks, strokes, cancer ( most likely), neurological disease, autoimmune disease like diabetes. Locally this is anecdotally because our resources are low and therefore slow. Clinically I know this is both vaxed and unvaxed with unvaxed again fairing worse especially with repeated infections. Most people are on their 3 rd infection within a 4 year period. Kids are very much effected and we continue to have chronic absenteeism in schools and our community is very much unvaxxed in that population. Learning referrals are through the roof in the younger grades with up to 25% of kinder classes being referred.
Did you ever consider chronic absenteeism may be an artifact of closing schools for extended periods between spring 2020 and 2021? Would explain why these problems you face aren't happening in the countries which only had brief school closures (Nordic countries, South Korea, etc).
We do see that chronic absenteeism here in Cleveland, but it disproportionately affects inner city schools. Since vaccination rates are near zero for children regardless of income, that would suggest it's a function of disruptions social support systems getting poor kids to school. Shouldn't be surprised this would happen.
Also, very few children were vaccinated against Covid across the world, and most countries have suspended covid vaccines under the age of 55/65, indicating this problem you face may be unrelated to Covid vaccines - or, these countries would have lots of problems.
Yes, that is the discussion but in 2020 and 2021 these children were just born. The problem is with the younger population not the older ones. The children would have been at home regardless ( those that are 5 and under) and in our community we did not shelter at home or wear masks in the home. We are seeing this clinically. None of the babies are getting vaccinated in our community. Maybe a handful. You don’t have children in school do you?
Data from Africa, where malaria still kills hundreds of thousands yearly and testing for COVID was sorely lacking during the pandemic, is highly unreliable.
Can you imagine a governmental response that simply said "there's nothing we can do; it's all futile" and leave the public to every conceivable individual practice in the face of rising illness?
Yes. It’s what we did for every previous pandemic since antibiotics and modern medicine largely eliminated threat of colds and flu. Nothing done for Hong Kong Flu, Asian Flu, SARS 03, Swine Flu 09, MERs nor any of the previous Coronaviruses we discovered - zero excess deaths.
Don’t panic, don’t disrupt supply chain, don’t crate untended shortages of healthcare by causing a cascade of chaos. That was old play book.
We thought Covid was about to hit us so we closed down. It turns out it was already here months earlier than we thought, and there were no excess deaths. That fact should weigh heavily on how we apprise our actions. The fact Covid was freely spreading for months and there were zero excess deaths is a strong counterfactual to hypothesis any of our measures mattered.
Immediately after shutting down we see deaths rise - not before. Not anywhere. It’s tied immediately to shutting down. For Wuhan, that means zero excess deaths until 1/23. For Italy that means deaths spike following 3/9. For the US it’s 3/14.
Why was this super deadly, immensely contagious disease not causing any excess deaths until we did something?
I know it’s hard to admit that we probably caused many of those excess deaths, just as it was hard for bloodletters to admit they killed people, or admit aspirin overdoses if you were a physician in 1918.
Panic has never helped in a crisis, and that’s exactly what we did. The unintended consequences are what we have to carefully go through now.
I do agree we have spotty data from Africa*, but our attempts to find covid deaths in Africa has turned up empty, and we’ve gotten pushback from African health leaders for suggesting there must be a hidden death toll they haven’t measured (away from my notes at the moment, but you can google New York Times Africa COVID, should see a few stories, read them chronologically, NYT loses interest trying to find COVID in Africa after their 2022 article on the “mystery of COVID in Africa).
Uganda, if I recall correctly, did lockdown and follow the West on Covid containment, but it caused blood shortages, increase in maternal mortality rates, and a slew of problems so they quickly dropped everything. I’d have to check my notes on Uganda, that’s my understanding.
Due to the constraints of time, my thoughts on this article will have to be limited to this: I detect a certain bias in the authors and also find some of their reasoning to be questionable. Just my 2 cents.
A significant portion of the US population has no interest in learning anything about the Covid-19 pandemic response. Nor do they have any interest in authentically listening to those who made decisions at the time. The 'Fauci hearing' was solely an excuse to vilify and tear apart a man they already hated and to throw red meat to their frothing base.
In their belligerence, they will be far less prepared for the next pandemic, and far more likely to thus suffer and die because of it.
I admire your dedication, commitment to communication, and your willingness to bridge divides, which is why I support your blog, but your audience (by your own statistics) is largely comprised of people who are already open-minded and searching for evidence-based, scientific answers. Not those who make up most of the frothing base, IOW.
PS. I'm curious - did you / will you ever have the opportunity to write for Kelley Krohnert's blog (as she did for yours)? Or was that just a one-way street?
"your audience (by your own statistics) is largely comprised of people who are already open-minded and searching for evidence-based, scientific answers"
Dr. Jetelina, we are the same harmonic frequency when it comes to reflecting on the pandemic.
Your analysis supports my view that the worst aspect of "long COVID" is an all too pervasive pandemic blindsight, that is, looking back at what happened but misunderstanding or grossly distorting what happened and why. Alas, performances like the Fauci hearing only cause further confusion and erosion of trust. In my state, we would call it a goat rodeo.
Was our pandemic response imperfectly human? Absolutely yes! But such imperfection is inevitable when human societies find themselves in an existential struggle where rapid mobilization in the face of the unknown and the unknowable is indispensable because delay entails death and invites defeat.
It is right to remember and mourn those who lost their lives to their typically painful and prolonged struggle with the SARS-CoV-2 pandemic virus. I have two dear friends among them. Even so, deaths were not the only concern and indeed, for me in my role as Commissioner of public health in a populous state, the mortality rate took second place to the prospect that our hospitals could be overwhelmed and therefore knocked out of commission by the flood of COVID-infected patients who would, indeed, die without the level of care that only a hospital can provide. The only way to avoid this catastrophe was to decrease the spread (prevalence) of the infection to manageable levels.
But how??!! We had no quantitative data that linked cause and beneficial effect. Your point about not having randomized controlled studies is an excellent example of this profound limitation.
Hospitals can fill up and when they do, they go on what is called "diversion," that is, ambulances are directed not to bring patients there. That would have affected everyone needing hospital care: women in labor, kids with appendicitis, families in car crashes and people in urgent need of stents to preserve their hearts or brains.
On January 20, 2020, I told my Governor just that - that the real existential risk to society was the collapse of our hospital system and the panic that would ensue. Panic means chaos and chaos is the prelude to catastrophe. In my state, we came way too close for comfort during four distinct inpatient hospital surges over the course of the emergency phase of the pandemic.
The root cause of Pandemic Blindsight was the serious failure of effective Crisis Communication (CC).
CC is a discipline in its own right and the primary duty to provide effective CC falls on elected leadership. That is what they are elected to do. They cannot do it alone, but they are captains of the ship and therefore responsible for how the emergency is addressed.
For me, there are four major elements of effective Crisis Communication if you have the duty of shepherding society through a major emergency:
1) You must be first with all pertinent news [very difficult in our age awash with universal access to light-speed communication];
2) Be clear about what is known and what is not known and prepare the public that guidance will change as knowledge accumulates; this is a good thing, not a sign of failure. [Failure on this point and the mistrust that ensued is arguably the root cause of Pandemic Blindsight.]
3) Give people tools (knowledge, behaviors and later, medications and vaccines) to protect themselves and the ones they love.
4) Explain, in accessible language, how these tools work and the benefit to the individual and community if they are widely adopted and the risk to the individual and community if they are not.
Imagine how differently we would view our response to the pandemic if these CC principles had been understood and followed by everyone in authority who bore the duty of leading us through the pandemic.
For our nation's Chief Executives, the pandemic could have been and should have been their "Winston Churchill Moment." The main messages: this is serious; this will be painful; there will be unequal sacrifice; we will be victorious if we remain courageous and each one of us steps up and together we do all we can to achieve victory. But, neither pandemic POTUS sent that message and now that horse is out of the barn.
The erosion of trust presents a deadly serious risk to national security. I know that sounds hyperbolic to some, but I and others offer it soberly. We now - in the long shadow of Pandemic Blindsight - live in a society where too many loud and influential voices cry that "The government is full of stupid liars. If you're smart, you will do the opposite of what they tell you." That, my friends, is a recipe for catastrophe.
As Dr. Jetelina has written previously, we must form our own truth-telling communities if we are to combat the mis- and disinformation that plagues us...before its too late.
History is not over. We will face other national / existential emergencies in the future. Count on it.
As an ordinary citizen with no particular expertise in any of these fields, I think you hit the nail on the head. I had the feeling that we had an enemy attacking us with no leadership in sight, and half the country was refusing to believe that we were being attacked or attacking the soldiers. I do think Biden tried to take the bull by the horns but by then it was too late and federal vax mandates just exacerbated an already developing divide. Hospitals being overwhelmed was a true issue- during one of the surges my toddler grandson was misdiagnosed by an overwhelmed ER doc as having "just a flu bug" when in fact he had salmonella poisoning. My daughter trusted her mom instinct and drove an hour to a Children's ER so something that could have been horrific was avoided. But she waited 5 hours in the first ER and 3 in the next. We should be doing an assessment of what we wrong and what we got right, but most people (even those of us who took it seriously) don't seem to want to think about it.
As a pediatrician, father and grandfather, I understand the panic the grips a parent when they know their child's medical needs are not being met. I hope everything turned out OK in the end.
We absolutely have not learned the lessons we must learn from our pandemic response.
The basic questions of what worked and what did not are not being systematically addressed. Some of them - like what benefit did masks provide - probably cannot be definitively answered because of all the confounding variables. But EVEN KNOWING THAT would provide invaluable knowledge for future emergencies.
I especially agree that mandates - all "mandates" - backfired in ways that led to unnecessary suffering and death.
In perfect hindsight, the leaders' message should have been, "We don't want to make you do anything, but we do ask you to please do everything you can to contribute to victory." That may be 20/20 hindsight, but it is also a lesson for the future.
Sadly, on the other end of the spectrum, I spoke with an ICU doctor colleague who reported that a distressing number of individuals "completed their myocardial infarction at home" during the pandemic, meaning that they did not present to the hospital for care. As a consequence, my friend related that they were seeing complications - especially actual loss of cardiac tissue - that they had not seen in 20 years.
Again, it was about communication of information that people needed, not the spin that folks on stage thought made them sound confident, powerful or smarter than everyone else in the room.
Fortunately the Children's Hospital correctly diagnosed him and with a week of in-hospital IV rehydration therapy he was good to go. But it's a stark example of what can happen when ER's get overwhelmed.
Thank you so much for this very cogent addition to this blog. It should appear on the front page of every communication out there and sent to every person on a leadership position in this country at ALL levels of government which is where the failures occurred…especially in my state where public health officials were threatened. You aren’t a David Downer, but a realist which we need now more than ever! As I continue asking, where’s the plan for the next emergency and are we ready?
My real dream is what I call the US Pandemic War College. Yes, the title is a bit over the top, but the idea would be to create a robust, ongoing collaboration of professionals in public health, emergency management / preparation, academia, industry, PHARMA, the military, hospitals, doctors, nurses, hospital systems, select elected officials at all levels and their staff and - perhaps most importantly - journalists.
In my dream, every participant learns and every participant teaches.
Nations establish war colleges because they know victory depends upon the leader of each unit sharing a fundamental common understanding of what it takes to win and being able to lead to that goal without having to wait for top-down orders; having trust in other leaders and having a clear sense of what other leaders are saying and doing and why.
The College would start with the pandemic because there is plenty of untilled, fertile ground there. Ideally, it would - quite naturally - expand beyond the pandemic and address emergency preparedness, response and the crucial role of Crisis Communication in all emergencies.
Thank you, Ms. Klopp. As you and others may be able to tell, this is my favorite topic not related to my grandkids.
Fortunately, in spite of all the vitriol and froth, plenty of research continues to be focused on COVID and Long COVID. Certain levels of surveillance, particularly wastewater evaluation, is ongoing in most cities. More is being learned, validated and published all the time. The deniers, conspiracy theorists and armchair critics will always be amongst us, amplified by the very media we are enjoying. Who was it who quoted "The masses are asses..."?
It spurred me to learn more about wastewater surveillance. I can't say that I dug deep, but did come away with two impressions: First, most current surveillance is (still) tuned to the SARS-CoV-2 virus. Given that measures of population (herd) immunity indicate that high levels of antibody mediated immune protection against COVID is now widespread (see the CARES project in the UT School of Public Health), the bulk of what seems to being done today is - in my mind - of questionable bang for the buck, since the threat of a resurgence of the pandemic has passed, for all practical purposes. Secondly, wastewater surveillance is not capable of identifying a novel pathogen de novo.
Agree though, that this technique could prove invaluable in certain circumstances and is a capability that deserves to be expanded in the name of preparedness.
There is, indeed, plenty of scientific work going on regarding COVID and long COVID. That is good.
My beef (obsession?) however is the need for widespread understanding and practice of the principles of effective Crisis Communication.
From a public / population health perspective, the deep-dive science of the pandemic (e.g., virology, immunology, epidemiology, mode of transmission) was the "easy" part of the puzzle. The answer was Prevention, Prevention, Prevention!
The hard part for public health professionals and elected leaders was to craft policies that balanced moderating the rate of infection (prevalence) with the need to keep society functioning by permitting the production, distribution and access to vital goods and services. Americans had to be willing to abide by the guidance and that's where effective Crisis Communication comes in. God Bless Us, we don't like being bossed around.
What to ask for (and expect) to combat the pandemic was an exercise in practical politics and an acid test of the ability of our free society to prevail in the face of an invisible, implacable foe - the COVID virus.
The Pandemic was the societal equivalent of war: a matter of life and death; unequal sacrifice; anxiety; great cost; and the need to make decisions with all deliberate speed in the face of incomplete information. Indeed, unlike any war preceding it, in the pandemic, the enemy managed to invade and occupy the entire country.
We should look back thoroughly and objectively - as we would in the wake of any war - and determine what went right, what went wrong and why. Only such a sober and sustained commitment can restore confidence in our defenses and thereby promote the trust that essential to effective collaboration in an emergency.
I love the idea of a Pandemic War College. As a (now retired) teacher I can tell you our school children paid a great price. Some of it was necessary, but how much? I think we could have and should have gotten them back in school in person much sooner but we had little data to go on and by the time the decisions were being made the nation was at war with itself over it. Schools, of course are not only occupied by children with low vulnerability but also by teachers and staff with higher levels of risk; they go home to be cared for by parents and grandparents who might also be at risk.
Ms Mueller, you describe the public health policy dilemma perfectly.
Consider classrooms and daycares - the quintessential congregate settings where effective infection control is a practical impossibility and which are notorious for being places where respiratory viruses spread back to families and then beyond.
It was known (or widely believed)that healthy children were at low risk for serious disease (i.e., hospitalization or worse). However, not only were their households at risk (grandma, grandpa and anyone with serious co-morbidities), but, as you point out, the teachers and staff are not all low risk.
I my opinion - then and now - the teachers who balked at returning to the classroom were given a bum rap - after all, everyone has the right to speak up for their own health interests.
As to your most pointed question - could have and should have we returned to in classroom instruction sooner?
That, Ms. Mueller is a perfect topic for the Pandemic War College. If it is even possible to use data to answer this question, I think it will have to be in retrospect. Regardless of what we find - either solid answers or that solid answers elude us - that will be invaluable knowledge for any future pandemic caused by a respiratory pathogen.
Thank you so much for your comments. I am heartened to see that this topic is generating a very healthy exchange of ideas.
In this discussion, you and too many others, including the NYTimes and the WaPo, continue to treat these Republicans as if they were simply making mistakes. These questions are based on calculated lies, not misstatements, not ignorance, but intentional deceit.
You can show how these lies are false to fact, but never forget they are intentional.
There is a good bit of ideologically-driven lying going on, but I've been listening to and reading the things said by the folks you're referring to long enough to know that many of them *do* believe what they're saying. So, a mixture of lies and genuine (if partly willful) misunderstanding.
Your comment reminds me of how in the 1st Trump regime NPR wouldn't label his lies lies, because they stated it was impossible to verify that he intended to deceive. You could say, "It's impossible to verify that Harvard graduate believes the lies they are repeating." But be sure to label it a lie.
I'm not sure I'm following you here. I've said that there is "a good bit of ideologically-driven lying going on" by Trump loyalists. You seem to be saying that I'm wrong to say that not *everything* those Republicans say about COVID and the official policies connected to it is a lie --- to be clear, an intentional false statement --- but rather that they do often (mistakenly) believe what they are saying. If that's indeed your view, we'll just have to agree to disagree.
(1) while your logical analysis, which is sound, as far as it goes, is compelling in the abstract, it does not, IMO, get us very far in the real world; and
(2) you're now presenting a different, more complex argument than you presented initially --- an interesting argument but one that I'm not inclined to pursue here. Have a good day.
Outright distain for all other voices of authority distinguishes the CF (Ex45) amongst those who cannot offer any reference for their beliefs. When you yourself are your only reference point for your world view, there are no constraints on what you choose to believe or speak about publicly. It's a very short step from speaking untruths to speaking outright lies.
I worked primarily at the state level, for 35 years. I kept seeing Dr. Fauci stepping into public health issues that were properly in CDC’s domain — Fauci is an infectious disease specialist, not an epidemiologist. Or preventive medicine expert. . This is not just about COVID — it happened on many other issues too.
Perhaps this happened because Fauci was local to the national press corps, in Washington, while during COVID CDC was far away and being led by a series of nonentities. Those at CDC who actually knew something were being muzzled.
What one is decades into one's career can be substantially more or different from the title on their diploma. Where was the top brass of the CDC when national spokespersons were needed desperately? it's not like the doors were locked and the press barred from access.
Actually I believe the press was effectively denied access at CDC to all but the designated spokespeople, during COVID — starting early on when Nancy Messonier told the truth about the seriousness of the epidemic and was promptly locked away….. I had a similar experience during the 2009 H1N1 influenza epidemic, when I told the truth about how serious the epidemic could be — FL could have as many as 5 million infections, I said— and was never allowed to do an interview again. (When the epidemic was all over, our serologic surveys indicated that we had in fact had just about 5 million infections).
To me it wasn’t any rule instituted that was a mistake. We were making the best decisions with the information we had. What was a huge error that didn’t have to happen was the failure to modify the rules when it became apparent that a rule was unhelpful. I’m just so angry that there was no push for immediately opening up parks and outdoor spaces AS SOON AS it was clear that was so much safer than indoors. The parks, playgrounds and lakefronts in Chicago were closed for far too long with the consequence of pushing people indoors. The health leaders should have been apoplectic and on the mayor to change course immediately.
The two case reports that convinced me this virus was transmitted mainly as an aerosol came out in April of 2020. One was an outbreak at a call center in South Korea and one was at a restaurant in China. Earlier, the widely reported Community Chorus outbreak in the US had made me suspect droplets alone weren't the whole story, but it was the two reports from South Korea and China that convinced me.
Thank you so much for lending your eloquent and intelligent voice to setting the record straight here. This, to me, is a central point, and bears repeating: “Public health leaders stepped up during a time of great uncertainty using systems too old to succeed while losing, at its peak, 3,500 people a day. They had to make incredibly difficult decisions, often with incomplete information, many of which were valid decisions based on the data at the time. Yes, they made mistakes, but their service was heroic and patriotic, too. We can live with these two truths. If not, we risk losing public health leaders — why would someone step up when this is how they’re treated?”
Thank you for calling out the lack of focus on true 'after action review' of the pandemic scenario vs. the political grand standing and attack on a key public health official. Thank you also for pointing to helpful resources and people doing the real work of ACR. Continue to shine a light on the real learnings we need to bring forward.
Thank you for this post, especially the "This policy wasn’t pulled out of thin air" part. Speaking as someone who has admired Dr. Fauci's decades of public service, and who is also pro-mask and pro-vaccine, I've been deeply frustrated by the inexcusably poor statements that Dr. Fauci has made over the last four years regarding certain basic and very important pandemic-related topics (e.g., "It sort of just appeared..."). He has, I regret to say, done a great deal of damage to the credibility of public health officials.
Has anyone analyzed why the CDC's response was, in general, so terrible? I'm also thinking of their forcing people to use their slow-to-release and inaccurate test for SARS-CoV-2, while even poor nations like Vietnam rolled out better tests faster.
Because of who was president at the time. They were hamstrung by that administration on many levels. Amd they have continued down the path of the worst advice and policy since. The CDC is illegitimate to me at the moment. I don't trust them at all anymore.
This is such a powerful and important assessment made here by Dr. Jetelina. I watched the back and forth with Dr. Fauci and felt sick about the whole thing. Of course we know where six feet came from! This was not new. As someone who has worked on the ground with state, community and local healthcare leaders to bring awareness to the most vulnerable citizens and debunk conspiracy theories in order to pave the way for people to get vaccinated and protect themselves, hearings like these set us back significantly. It is full time for our nations leaders to start having substantive conversations about how to prepare for the next pandemic, instead of trying to find a scapegoat for the past one.
Thank you for your thoughtful and balanced opinions in this space. You make a difference in a world that sometimes feel like it has gone completely mad.
Thank you. I often say I wish I could take people back in to the hospitals in the early days of Covid. It was terrifying. We had no idea what to expect. The rules were changing daily. No PPE. Freezer trucks full of bodies. To see people attack Dr. Fauci enrages me. They have no idea what we were dealing with. Thank God for scientists like him, like you, who were giving us some guidance.
Bring Musk back into the hospital and let him eat cake from the floor. What a disgusting quote and propaganda poster. What a dangerous person and general backlash against all of us for whom they once banged pots and pans at 7PM, rallying our spirits to keep taking care of the sick and dying while putting ourselves in harm’s way.
We have the answers to the questions posed in this article already. It’s just a matter of who gets to answer them… those demagogues with ulterior motives, or us on the front lines serving who could easily walk away, save for our integrity and calling.
The pundits and deniers have not considered the fact that, had we not respected science, we'd still have children dying from the measles, crippled from polio and marred by small pox. The delivery of multiple vaccines that miraculously and dramatically reduced the rate of death, ICU admission, mechanical ventilation and hospital admission within a short 12 months of outbreak of the COVID virus is a true miracle of modern science, but the pundits and deniers haven't acknowledged that. Even with the vaccine widely available, it took months and months to reach vaccination levels between 60-70% of the eligible population. If you're not an expert yourself and people are dying all around you, why would you possibly choose to deny that professionals with lifelong dedication to fighting disease know less than you about public health measures and the efficacy of vaccines? It defies even first-grade logic.
It's so hard to believe this was only 4 years ago. You would think it was so long ago that few people have a living memory of it the way some people are second guessing - not in a productive, but in a destructive way - everything that was done
Decisions were made with the information on hand at the time, and constantly evolving as information was updated. Hindsight always seems to be 20/20 but if not for Dr. Fauci and the other scientists, the situation could've been even worse than it already was. Thank you for being here and writing this newsletter to keep us all better informed.
"it could've been worse had we not shut everything down and drew Xs 6-feet apart on the floor at Walmart!"
Nobody is buying this BS anymore.
You don’t think there would have been more spread of Covid if we had been standing shoulder to shoulder?
The virus is aerosolized, but is also spread by droplets. Reducing one kind if exposure doesn’t eliminate the entire risk, but it probably helps. Of each of the mitigation steps, 6 foot distancing seems like one of the easiest.
There's no way the virus could spread so rapidly and broadly if it wasn't almost entirely spread by aerosols. We were never going to be able to suppress this virus. That was clear at the beginning to anyone thinking critically who was not blinded by hubris
Can you repeat your points while thinking critically and while not being blinded by hubris?? The FACT is that infection is the product of level of exposure X length of that exposure. So every foot of distance that reduces the concentration of an airborn pathogen and every minute that reduces the length of that exposure is critical. THAT is CRITICAL thinking and done without hubris! So, yes, 6 ft separation helps!!
Please tell us what you would’ve done Paul. You’re so quick to call BS, to point fingers at the ones who stood up and tried to contain this sh*t-storm but what would YOU have done? Nothing?, no shutdown? No distancing? Why not, let’s not wash our hands… Right! That would’ve been fun to watch the entire health care system crumble. You criticize yet offer no solutions… let’s all put you in charge of the next pandemic.🙄
For starters, I wouldn't have created mass hysteria. Hysteria is extremely dangerous - the media and politicians ran with the fear porn and the rest is history. The data from the Diamond Princess cruise ship told us everything we needed to know, really. The virus was airborne and very contagious, but presented as fairly mild respiratory illness for the vast majority of the population. Older people with co-morbidities are most at risk.
This is essentially what Fauci said in the New England Journal of Medicine on Feb. 28 - this virus is akin to a severe seasonal influenza with IFR well below 1% (it's actually below 0.1% for most of the population)
I also would have been honest with people and told them that the virus was almost certainly spreading here well before we started testing for it in the United States. And the idea that China "discovered" it in Dec 2019 is silly - it was spreading well before then.
If it WAS akin to a severe seasonal influenza (BEFORE it evolved…), please explain how it is that an entire hospital department of 30 patients AND an entire ICU filled up with COVID patients needing respiratory assitance (and on ventilators in the ICU)… ALL with COVID infections… Right here your reasoning is wrong. You should reassess your thinking about all this!
And by "nobody" you mean "everyone who understands the phenomena involved", of course.
would you present your credentials, please, Paul?
Wrong!
TFG fired the Pandemic Response Team in 2018. Simply because Obama created it. We know who the bad actors were. The problem is that too many people listened to the conspiracy theories, and were already brainwashed not to follow the rules of public health and safety, for decades. The anti-vaxxer/science movement of the past decade plus didn't help and neither did social media platforms that still allow disinformation and misinformation to flow freely on their platforms with no recourse for those that constantly report it to no avail.
You have perfectly expressed exactly what I feel. I live in a deep red rural area of SW Michigan where "Proudly unvaccinated!" was a battle cry against big government control. No problem, though: these neighbors didn't need vaccines because they had Jesus. Needless to say, I stayed home a lot.
Thank you for brightening my day!
I hope Jesus welcomed them with open arms at the Pearly gates when they arrived early, without reservations!
Dr. Jetelina, as a retired physician I read your column regularly, and I thank you sincerely for your well-researched, balanced and clear information. Recently a report was published in BMJ re: Pandemic excess deaths. It implies that basically all the mitigating measures, including vaccines, appeared to have no effect on excess deaths. The authors did list many limitations of the study, and clearly these are numbers without a lot of specificity. But it is already being cited by anti-vax, far-right conspiracy theorists as proof that Covid vaccines and other mitigating behaviors do no good. If you could address this in a column it would be great - Thank you again. https://bmjpublichealth.bmj.com/content/2/1/e000282
The vaccines didn't prevent transmission and the NPIs (masks, social distancing, etc.) all failed. It's painfully obvious to nearly everyone by now.
suppressing a contagious, highly mutable airborne virus was never a feasible strategy.
Vaccines were hoped to prevent transmission, but more importantly, they were hoped to to reduce severe disease. They achieved the first for a few months, and have achieved the second since they were introduced.
We should remember that the measures to “slow the curve” in spring 2020 really did “slow the curve.” Did it stop the pandemic? No. Did it let hospitals catch up and be more ready to help the thousands sick? Yes.
the measures to “slow the curve” in spring 2020 really did “slow the curve.”
There's no evidence to support this, though. Spring waves of respiratory viruses come and go every year without us implementing "measures" It's incredibly arrogant to think we have control over these phenomena.
As far as the vaccines go, be honest with the public from the start. Say "we hope" instead of "we know". Don't mandate and coerce and publicly shame.
Please stop making up a false history, then pretending it is reality.
Oh, please...a world-wide immunologically naive population, many millions of tiny children, adults living with co-morbid risks and a rising worldwide elderly population was a ticket for mass casualties, which actually occurred. You can't compare this to the average flu season. Only now, with broad vaccination, broad population exposure rendering a degree of herd immunity can COVID be considered endemic as opposed to epidemic, and there are still places on earth where essentially no-one has been vaccinated. Show me a common cold virus or influenza that produces Long COVID. Would you really like to return to a world without smallpox, polio, influenza, rubella, measles, mumps protection? Perhaps you weren't alive before there was protection from these? In 1918-19, an unvaccinated world lost millions of lives to the "spanish flu". Now, after we've experienced another (hopefully) once in a lifetime pandemic, the pundits and deniers are already out in force. Unbelieveable...
So if what you are saying "vax and social distancing" didn't help, why were fatalities (and exceeds deaths), LESS than half of US deaths? Canada has a higher vax rate than the US, and best I can tell from my travels took social distancing guidelines more seriously than in the US
Don’t bully and expose your made-up “facts.”
Hospitals were not overwhelmed Spring 2020, there was nothing to catch up to. That is a Mandela Effect or something, you are misremembering history.
We pre-emptively halted elective medicine, anticipating a surge that never came.
It's possible (I would argue likely) that this decision had the unintended effect of lowering staffed beds by 20% which persists today unfortunately (we were at roughly 920K beds nationwide pre March 2020, been hovering 700+ since then IIRC). It's a very complex cascade of events that lead to this point.
Countries which did much less, reopened schools, didn't halt elective medicine, had brief lockdowns, etc fared better.
Hey Mike, I sent you an email from my Bert Fenster email account.
Sorry, just saw it - too much spam and missed it. Safe travels! I will reply soon.
:) ! Gracias.
Wrong on all counts. https://www.bmj.com/content/375/bmj-2021-068302
My comment is to the "slow the curve" comment by Paul, not to Josh.
Do you mean this paper that Dr. Susan Oliver tore to very small pieces?
https://www.youtube.com/watch?v=dJfvF5CEy9U
Yes! I had not seen her video, and will watch the whole thing today. When I read the article I realized that quite possibly the very *limitations* the authors admitted to might be the key to the whole mystery of why the numbers seem to imply ineffectiveness of anti-Covid measures. Thank you for sharing the video link.
You don't need to be "far right" or "anti vax" to see that mortality figures do not support the mitigation hypothesis. I haven't read the linked paper, but it is true that mortality largely increased following rollout of vaccines in many, many countries including South Korea, Germany, Australia, Finland, Denmark, Canada, Taiwan, etc.
It is also true many countries saw no change in excess mortality following vaccination including the US, Portugal, Netherlands, Austria and Israel.
And it's also true many countries did see some decrease in all cause mortality including Italy, Sweden, and Belgium. Others saw a "dead cat bounce" like France and Spain.
Of these examples, what happened in South Korea in 2022 I believes deserves the most scrutiny. The country praised for "doing it right" had one of the largest increases in all cause mortality of *any* country in the world, *after* they were fully vaccinated and *while* still wearing masks (behaviors didn't change either - back in school spring 2020, lockdowns lifted, etc).
On the other hand, why did countries like Bulgaria, which had very low vaccination rates, *not* pay any price in terms of all-cause mortality? They returned back to baseline by 2022. Why didn't Covid overwhelm Africa as predicted (remember how much concern there was on "equitable" access, now we are throwing out millions of doses Africa didn't use).
Presently, almost every country in the world now only recommends Covid vaccines in limited cohorts. Very few, even in those cohorts are taking them. Demand as plummeted, and despite claims from many in Public Health that this is a mistake and deaths will follow, all-cause mortality in 2023 in every country largely returned back to baseline.
You can be "pro vax" while acknowledging some vaccines don't work. Ralph Baric wasn't "anti vax" when admitting he didn't understand why the Covid vaccines he was testing on humanized mice made them sicker to other Covid strains. Michael Osterholm wasn't antivax when admitting scientists don't understand why flu vaccines often fail.
My biggest complaint the last four is that promoters of all of these extraordinary claims have constructed their arguments so they cannot be falsified.
No amount of counterfactuals make them alter their convictions, which is why it seems a lot of this was all pseudoscience after all.
Clean version of all-cause mortality for selected countries, if interested. Still need to get South Korea before I update to 2023:
https://docs.google.com/spreadsheets/d/1klmb3_vdhClF3Js2RdugsoY83L2moAI-ae2Rgb3F5mw/edit?usp=sharing
I'm sorry but a google sheet without the actual link to the countries data does not count as proof. I'm on the ground and I see excess death from COVID and the many months of damage from COVID. Many unvaccinated persons have less antibodies than vaccinated when I test. Additionally, when unvaccinated persons microclot and are positive with fibrinogen activity and d dimer levels they do worse than vaccinated at this point. Anecdotally and epi wise, vaccinated fair much better even with acute covid and long covid. https://www.webmd.com/vaccines/covid-19-vaccine/news/20240221/vaccinated-people-lower-risk-long-covid-study
Where are you located? In the US excess deaths are back to near zero. Compare 1st 17 week average all-cause mortality of 2024 (60, 859) to 2019 (57,285) to 2015 (55,713). This is holding true for many countries.
The data set I put in google sheet pulled from mortality.org, which aggregates each country CDC reporting and then passes through to Our World in Data. If you trust the CDC or OWID, you are trusting that data set. You can create here:
https://www.mortality.org/Data/STMF
Just download "STMF output file (xlsx or pooled csv): weekly death counts" and drop in pivot table, filter Sex to "B" (both).
Unfortunately the CDC shut down a lot of the weekly reporting in 2023 that gave quick weekly updates (like https://data.cdc.gov/NCHS/Weekly-Provisional-Counts-of-Deaths-by-State-and-S/muzy-jte6/), and CDC Wonder lags quite a bit, so if you have some data set showing where you are that excess deaths are high I would appreciate you sharing.
As for the WebMD article, based on this study https://www.sciencedirect.com/science/article/abs/pii/S1047279724000310
I am not going to spend time assessing a study based on surveys, which are among the lowest tier of evidence.
Maybe that is true, maybe not. If it is true, we should expect to see Long Covid crippling the continent of Africa as well as countries like Bulgaria, Poland, Lebanon, Syria, Ukraine, etc. Quick google doesn't turn much up.
I’m located in an area where the lowest vaccination rate is 10% and the highest is 42%. Covid is kicking our community with complications of long Covid Ie. Heart attacks, strokes, cancer ( most likely), neurological disease, autoimmune disease like diabetes. Locally this is anecdotally because our resources are low and therefore slow. Clinically I know this is both vaxed and unvaxed with unvaxed again fairing worse especially with repeated infections. Most people are on their 3 rd infection within a 4 year period. Kids are very much effected and we continue to have chronic absenteeism in schools and our community is very much unvaxxed in that population. Learning referrals are through the roof in the younger grades with up to 25% of kinder classes being referred.
Did you ever consider chronic absenteeism may be an artifact of closing schools for extended periods between spring 2020 and 2021? Would explain why these problems you face aren't happening in the countries which only had brief school closures (Nordic countries, South Korea, etc).
We do see that chronic absenteeism here in Cleveland, but it disproportionately affects inner city schools. Since vaccination rates are near zero for children regardless of income, that would suggest it's a function of disruptions social support systems getting poor kids to school. Shouldn't be surprised this would happen.
Also, very few children were vaccinated against Covid across the world, and most countries have suspended covid vaccines under the age of 55/65, indicating this problem you face may be unrelated to Covid vaccines - or, these countries would have lots of problems.
Yes, that is the discussion but in 2020 and 2021 these children were just born. The problem is with the younger population not the older ones. The children would have been at home regardless ( those that are 5 and under) and in our community we did not shelter at home or wear masks in the home. We are seeing this clinically. None of the babies are getting vaccinated in our community. Maybe a handful. You don’t have children in school do you?
Data from Africa, where malaria still kills hundreds of thousands yearly and testing for COVID was sorely lacking during the pandemic, is highly unreliable.
Can you imagine a governmental response that simply said "there's nothing we can do; it's all futile" and leave the public to every conceivable individual practice in the face of rising illness?
Yes. It’s what we did for every previous pandemic since antibiotics and modern medicine largely eliminated threat of colds and flu. Nothing done for Hong Kong Flu, Asian Flu, SARS 03, Swine Flu 09, MERs nor any of the previous Coronaviruses we discovered - zero excess deaths.
Don’t panic, don’t disrupt supply chain, don’t crate untended shortages of healthcare by causing a cascade of chaos. That was old play book.
We thought Covid was about to hit us so we closed down. It turns out it was already here months earlier than we thought, and there were no excess deaths. That fact should weigh heavily on how we apprise our actions. The fact Covid was freely spreading for months and there were zero excess deaths is a strong counterfactual to hypothesis any of our measures mattered.
Immediately after shutting down we see deaths rise - not before. Not anywhere. It’s tied immediately to shutting down. For Wuhan, that means zero excess deaths until 1/23. For Italy that means deaths spike following 3/9. For the US it’s 3/14.
Why was this super deadly, immensely contagious disease not causing any excess deaths until we did something?
I know it’s hard to admit that we probably caused many of those excess deaths, just as it was hard for bloodletters to admit they killed people, or admit aspirin overdoses if you were a physician in 1918.
Panic has never helped in a crisis, and that’s exactly what we did. The unintended consequences are what we have to carefully go through now.
I do agree we have spotty data from Africa*, but our attempts to find covid deaths in Africa has turned up empty, and we’ve gotten pushback from African health leaders for suggesting there must be a hidden death toll they haven’t measured (away from my notes at the moment, but you can google New York Times Africa COVID, should see a few stories, read them chronologically, NYT loses interest trying to find COVID in Africa after their 2022 article on the “mystery of COVID in Africa).
Uganda, if I recall correctly, did lockdown and follow the West on Covid containment, but it caused blood shortages, increase in maternal mortality rates, and a slew of problems so they quickly dropped everything. I’d have to check my notes on Uganda, that’s my understanding.
*excluding South Africa
Due to the constraints of time, my thoughts on this article will have to be limited to this: I detect a certain bias in the authors and also find some of their reasoning to be questionable. Just my 2 cents.
A significant portion of the US population has no interest in learning anything about the Covid-19 pandemic response. Nor do they have any interest in authentically listening to those who made decisions at the time. The 'Fauci hearing' was solely an excuse to vilify and tear apart a man they already hated and to throw red meat to their frothing base.
In their belligerence, they will be far less prepared for the next pandemic, and far more likely to thus suffer and die because of it.
I admire your dedication, commitment to communication, and your willingness to bridge divides, which is why I support your blog, but your audience (by your own statistics) is largely comprised of people who are already open-minded and searching for evidence-based, scientific answers. Not those who make up most of the frothing base, IOW.
PS. I'm curious - did you / will you ever have the opportunity to write for Kelley Krohnert's blog (as she did for yours)? Or was that just a one-way street?
"your audience (by your own statistics) is largely comprised of people who are already open-minded and searching for evidence-based, scientific answers"
actually, the opposite is true
Whatever.
Your comment history speaks for itself.
Dr. Jetelina, we are the same harmonic frequency when it comes to reflecting on the pandemic.
Your analysis supports my view that the worst aspect of "long COVID" is an all too pervasive pandemic blindsight, that is, looking back at what happened but misunderstanding or grossly distorting what happened and why. Alas, performances like the Fauci hearing only cause further confusion and erosion of trust. In my state, we would call it a goat rodeo.
Was our pandemic response imperfectly human? Absolutely yes! But such imperfection is inevitable when human societies find themselves in an existential struggle where rapid mobilization in the face of the unknown and the unknowable is indispensable because delay entails death and invites defeat.
It is right to remember and mourn those who lost their lives to their typically painful and prolonged struggle with the SARS-CoV-2 pandemic virus. I have two dear friends among them. Even so, deaths were not the only concern and indeed, for me in my role as Commissioner of public health in a populous state, the mortality rate took second place to the prospect that our hospitals could be overwhelmed and therefore knocked out of commission by the flood of COVID-infected patients who would, indeed, die without the level of care that only a hospital can provide. The only way to avoid this catastrophe was to decrease the spread (prevalence) of the infection to manageable levels.
But how??!! We had no quantitative data that linked cause and beneficial effect. Your point about not having randomized controlled studies is an excellent example of this profound limitation.
Hospitals can fill up and when they do, they go on what is called "diversion," that is, ambulances are directed not to bring patients there. That would have affected everyone needing hospital care: women in labor, kids with appendicitis, families in car crashes and people in urgent need of stents to preserve their hearts or brains.
On January 20, 2020, I told my Governor just that - that the real existential risk to society was the collapse of our hospital system and the panic that would ensue. Panic means chaos and chaos is the prelude to catastrophe. In my state, we came way too close for comfort during four distinct inpatient hospital surges over the course of the emergency phase of the pandemic.
The root cause of Pandemic Blindsight was the serious failure of effective Crisis Communication (CC).
CC is a discipline in its own right and the primary duty to provide effective CC falls on elected leadership. That is what they are elected to do. They cannot do it alone, but they are captains of the ship and therefore responsible for how the emergency is addressed.
For me, there are four major elements of effective Crisis Communication if you have the duty of shepherding society through a major emergency:
1) You must be first with all pertinent news [very difficult in our age awash with universal access to light-speed communication];
2) Be clear about what is known and what is not known and prepare the public that guidance will change as knowledge accumulates; this is a good thing, not a sign of failure. [Failure on this point and the mistrust that ensued is arguably the root cause of Pandemic Blindsight.]
3) Give people tools (knowledge, behaviors and later, medications and vaccines) to protect themselves and the ones they love.
4) Explain, in accessible language, how these tools work and the benefit to the individual and community if they are widely adopted and the risk to the individual and community if they are not.
Imagine how differently we would view our response to the pandemic if these CC principles had been understood and followed by everyone in authority who bore the duty of leading us through the pandemic.
For our nation's Chief Executives, the pandemic could have been and should have been their "Winston Churchill Moment." The main messages: this is serious; this will be painful; there will be unequal sacrifice; we will be victorious if we remain courageous and each one of us steps up and together we do all we can to achieve victory. But, neither pandemic POTUS sent that message and now that horse is out of the barn.
The erosion of trust presents a deadly serious risk to national security. I know that sounds hyperbolic to some, but I and others offer it soberly. We now - in the long shadow of Pandemic Blindsight - live in a society where too many loud and influential voices cry that "The government is full of stupid liars. If you're smart, you will do the opposite of what they tell you." That, my friends, is a recipe for catastrophe.
As Dr. Jetelina has written previously, we must form our own truth-telling communities if we are to combat the mis- and disinformation that plagues us...before its too late.
History is not over. We will face other national / existential emergencies in the future. Count on it.
[Sorry to be such a David Downer.]
As an ordinary citizen with no particular expertise in any of these fields, I think you hit the nail on the head. I had the feeling that we had an enemy attacking us with no leadership in sight, and half the country was refusing to believe that we were being attacked or attacking the soldiers. I do think Biden tried to take the bull by the horns but by then it was too late and federal vax mandates just exacerbated an already developing divide. Hospitals being overwhelmed was a true issue- during one of the surges my toddler grandson was misdiagnosed by an overwhelmed ER doc as having "just a flu bug" when in fact he had salmonella poisoning. My daughter trusted her mom instinct and drove an hour to a Children's ER so something that could have been horrific was avoided. But she waited 5 hours in the first ER and 3 in the next. We should be doing an assessment of what we wrong and what we got right, but most people (even those of us who took it seriously) don't seem to want to think about it.
Ms Mueller, I agree totally.
As a pediatrician, father and grandfather, I understand the panic the grips a parent when they know their child's medical needs are not being met. I hope everything turned out OK in the end.
We absolutely have not learned the lessons we must learn from our pandemic response.
The basic questions of what worked and what did not are not being systematically addressed. Some of them - like what benefit did masks provide - probably cannot be definitively answered because of all the confounding variables. But EVEN KNOWING THAT would provide invaluable knowledge for future emergencies.
I especially agree that mandates - all "mandates" - backfired in ways that led to unnecessary suffering and death.
In perfect hindsight, the leaders' message should have been, "We don't want to make you do anything, but we do ask you to please do everything you can to contribute to victory." That may be 20/20 hindsight, but it is also a lesson for the future.
Sadly, on the other end of the spectrum, I spoke with an ICU doctor colleague who reported that a distressing number of individuals "completed their myocardial infarction at home" during the pandemic, meaning that they did not present to the hospital for care. As a consequence, my friend related that they were seeing complications - especially actual loss of cardiac tissue - that they had not seen in 20 years.
Again, it was about communication of information that people needed, not the spin that folks on stage thought made them sound confident, powerful or smarter than everyone else in the room.
Fortunately the Children's Hospital correctly diagnosed him and with a week of in-hospital IV rehydration therapy he was good to go. But it's a stark example of what can happen when ER's get overwhelmed.
Thank you so much for this very cogent addition to this blog. It should appear on the front page of every communication out there and sent to every person on a leadership position in this country at ALL levels of government which is where the failures occurred…especially in my state where public health officials were threatened. You aren’t a David Downer, but a realist which we need now more than ever! As I continue asking, where’s the plan for the next emergency and are we ready?
Thank you for your kind words.
My real dream is what I call the US Pandemic War College. Yes, the title is a bit over the top, but the idea would be to create a robust, ongoing collaboration of professionals in public health, emergency management / preparation, academia, industry, PHARMA, the military, hospitals, doctors, nurses, hospital systems, select elected officials at all levels and their staff and - perhaps most importantly - journalists.
In my dream, every participant learns and every participant teaches.
Nations establish war colleges because they know victory depends upon the leader of each unit sharing a fundamental common understanding of what it takes to win and being able to lead to that goal without having to wait for top-down orders; having trust in other leaders and having a clear sense of what other leaders are saying and doing and why.
The College would start with the pandemic because there is plenty of untilled, fertile ground there. Ideally, it would - quite naturally - expand beyond the pandemic and address emergency preparedness, response and the crucial role of Crisis Communication in all emergencies.
Thank you, Ms. Klopp. As you and others may be able to tell, this is my favorite topic not related to my grandkids.
Fortunately, in spite of all the vitriol and froth, plenty of research continues to be focused on COVID and Long COVID. Certain levels of surveillance, particularly wastewater evaluation, is ongoing in most cities. More is being learned, validated and published all the time. The deniers, conspiracy theorists and armchair critics will always be amongst us, amplified by the very media we are enjoying. Who was it who quoted "The masses are asses..."?
Thank you for your comment.
It spurred me to learn more about wastewater surveillance. I can't say that I dug deep, but did come away with two impressions: First, most current surveillance is (still) tuned to the SARS-CoV-2 virus. Given that measures of population (herd) immunity indicate that high levels of antibody mediated immune protection against COVID is now widespread (see the CARES project in the UT School of Public Health), the bulk of what seems to being done today is - in my mind - of questionable bang for the buck, since the threat of a resurgence of the pandemic has passed, for all practical purposes. Secondly, wastewater surveillance is not capable of identifying a novel pathogen de novo.
Agree though, that this technique could prove invaluable in certain circumstances and is a capability that deserves to be expanded in the name of preparedness.
There is, indeed, plenty of scientific work going on regarding COVID and long COVID. That is good.
My beef (obsession?) however is the need for widespread understanding and practice of the principles of effective Crisis Communication.
From a public / population health perspective, the deep-dive science of the pandemic (e.g., virology, immunology, epidemiology, mode of transmission) was the "easy" part of the puzzle. The answer was Prevention, Prevention, Prevention!
The hard part for public health professionals and elected leaders was to craft policies that balanced moderating the rate of infection (prevalence) with the need to keep society functioning by permitting the production, distribution and access to vital goods and services. Americans had to be willing to abide by the guidance and that's where effective Crisis Communication comes in. God Bless Us, we don't like being bossed around.
What to ask for (and expect) to combat the pandemic was an exercise in practical politics and an acid test of the ability of our free society to prevail in the face of an invisible, implacable foe - the COVID virus.
The Pandemic was the societal equivalent of war: a matter of life and death; unequal sacrifice; anxiety; great cost; and the need to make decisions with all deliberate speed in the face of incomplete information. Indeed, unlike any war preceding it, in the pandemic, the enemy managed to invade and occupy the entire country.
We should look back thoroughly and objectively - as we would in the wake of any war - and determine what went right, what went wrong and why. Only such a sober and sustained commitment can restore confidence in our defenses and thereby promote the trust that essential to effective collaboration in an emergency.
I love the idea of a Pandemic War College. As a (now retired) teacher I can tell you our school children paid a great price. Some of it was necessary, but how much? I think we could have and should have gotten them back in school in person much sooner but we had little data to go on and by the time the decisions were being made the nation was at war with itself over it. Schools, of course are not only occupied by children with low vulnerability but also by teachers and staff with higher levels of risk; they go home to be cared for by parents and grandparents who might also be at risk.
Ms Mueller, you describe the public health policy dilemma perfectly.
Consider classrooms and daycares - the quintessential congregate settings where effective infection control is a practical impossibility and which are notorious for being places where respiratory viruses spread back to families and then beyond.
It was known (or widely believed)that healthy children were at low risk for serious disease (i.e., hospitalization or worse). However, not only were their households at risk (grandma, grandpa and anyone with serious co-morbidities), but, as you point out, the teachers and staff are not all low risk.
I my opinion - then and now - the teachers who balked at returning to the classroom were given a bum rap - after all, everyone has the right to speak up for their own health interests.
As to your most pointed question - could have and should have we returned to in classroom instruction sooner?
That, Ms. Mueller is a perfect topic for the Pandemic War College. If it is even possible to use data to answer this question, I think it will have to be in retrospect. Regardless of what we find - either solid answers or that solid answers elude us - that will be invaluable knowledge for any future pandemic caused by a respiratory pathogen.
Thank you so much for your comments. I am heartened to see that this topic is generating a very healthy exchange of ideas.
In this discussion, you and too many others, including the NYTimes and the WaPo, continue to treat these Republicans as if they were simply making mistakes. These questions are based on calculated lies, not misstatements, not ignorance, but intentional deceit.
You can show how these lies are false to fact, but never forget they are intentional.
There is a good bit of ideologically-driven lying going on, but I've been listening to and reading the things said by the folks you're referring to long enough to know that many of them *do* believe what they're saying. So, a mixture of lies and genuine (if partly willful) misunderstanding.
Your comment reminds me of how in the 1st Trump regime NPR wouldn't label his lies lies, because they stated it was impossible to verify that he intended to deceive. You could say, "It's impossible to verify that Harvard graduate believes the lies they are repeating." But be sure to label it a lie.
I'm not sure I'm following you here. I've said that there is "a good bit of ideologically-driven lying going on" by Trump loyalists. You seem to be saying that I'm wrong to say that not *everything* those Republicans say about COVID and the official policies connected to it is a lie --- to be clear, an intentional false statement --- but rather that they do often (mistakenly) believe what they are saying. If that's indeed your view, we'll just have to agree to disagree.
I'm trying to formulate how one should respond to someone repeating a statement that originated as a lie.
A makes up a lie and repeats it
B News and C Social Media repeat it (without fact checking)
Elected official D repeats it (without having their staff fact checking)
etc.
Possible responses are:
You are an intelligent educated person. Should I assume that you really don't know that's false?
or
That statement is false. Are you repeating in ignorance or knowingly lying?
or
I don't know if you are aware, but that statement started as a lie. You are perhaps just repeating it in ignorance.
Probably none of these would work, but "I really believed it" was not a good defense for the Jan 6ers.
I take your point, but:
(1) while your logical analysis, which is sound, as far as it goes, is compelling in the abstract, it does not, IMO, get us very far in the real world; and
(2) you're now presenting a different, more complex argument than you presented initially --- an interesting argument but one that I'm not inclined to pursue here. Have a good day.
Outright distain for all other voices of authority distinguishes the CF (Ex45) amongst those who cannot offer any reference for their beliefs. When you yourself are your only reference point for your world view, there are no constraints on what you choose to believe or speak about publicly. It's a very short step from speaking untruths to speaking outright lies.
As a retired working epidemiologist, I thank you.
I worked primarily at the state level, for 35 years. I kept seeing Dr. Fauci stepping into public health issues that were properly in CDC’s domain — Fauci is an infectious disease specialist, not an epidemiologist. Or preventive medicine expert. . This is not just about COVID — it happened on many other issues too.
Perhaps this happened because Fauci was local to the national press corps, in Washington, while during COVID CDC was far away and being led by a series of nonentities. Those at CDC who actually knew something were being muzzled.
What one is decades into one's career can be substantially more or different from the title on their diploma. Where was the top brass of the CDC when national spokespersons were needed desperately? it's not like the doors were locked and the press barred from access.
Actually I believe the press was effectively denied access at CDC to all but the designated spokespeople, during COVID — starting early on when Nancy Messonier told the truth about the seriousness of the epidemic and was promptly locked away….. I had a similar experience during the 2009 H1N1 influenza epidemic, when I told the truth about how serious the epidemic could be — FL could have as many as 5 million infections, I said— and was never allowed to do an interview again. (When the epidemic was all over, our serologic surveys indicated that we had in fact had just about 5 million infections).
To me it wasn’t any rule instituted that was a mistake. We were making the best decisions with the information we had. What was a huge error that didn’t have to happen was the failure to modify the rules when it became apparent that a rule was unhelpful. I’m just so angry that there was no push for immediately opening up parks and outdoor spaces AS SOON AS it was clear that was so much safer than indoors. The parks, playgrounds and lakefronts in Chicago were closed for far too long with the consequence of pushing people indoors. The health leaders should have been apoplectic and on the mayor to change course immediately.
The two case reports that convinced me this virus was transmitted mainly as an aerosol came out in April of 2020. One was an outbreak at a call center in South Korea and one was at a restaurant in China. Earlier, the widely reported Community Chorus outbreak in the US had made me suspect droplets alone weren't the whole story, but it was the two reports from South Korea and China that convinced me.
just like war, you go with what you have at the moment
Thank you so much for lending your eloquent and intelligent voice to setting the record straight here. This, to me, is a central point, and bears repeating: “Public health leaders stepped up during a time of great uncertainty using systems too old to succeed while losing, at its peak, 3,500 people a day. They had to make incredibly difficult decisions, often with incomplete information, many of which were valid decisions based on the data at the time. Yes, they made mistakes, but their service was heroic and patriotic, too. We can live with these two truths. If not, we risk losing public health leaders — why would someone step up when this is how they’re treated?”
Thank you for calling out the lack of focus on true 'after action review' of the pandemic scenario vs. the political grand standing and attack on a key public health official. Thank you also for pointing to helpful resources and people doing the real work of ACR. Continue to shine a light on the real learnings we need to bring forward.
Thank you for this post, especially the "This policy wasn’t pulled out of thin air" part. Speaking as someone who has admired Dr. Fauci's decades of public service, and who is also pro-mask and pro-vaccine, I've been deeply frustrated by the inexcusably poor statements that Dr. Fauci has made over the last four years regarding certain basic and very important pandemic-related topics (e.g., "It sort of just appeared..."). He has, I regret to say, done a great deal of damage to the credibility of public health officials.
Has anyone analyzed why the CDC's response was, in general, so terrible? I'm also thinking of their forcing people to use their slow-to-release and inaccurate test for SARS-CoV-2, while even poor nations like Vietnam rolled out better tests faster.
Because of who was president at the time. They were hamstrung by that administration on many levels. Amd they have continued down the path of the worst advice and policy since. The CDC is illegitimate to me at the moment. I don't trust them at all anymore.
The Lessons from the COVID war book, written by the head of the 9/11 commission with input from experts is a good start to understanding
There was so much fraud selling PPE equipment and PPP money for fake business.
This is such a powerful and important assessment made here by Dr. Jetelina. I watched the back and forth with Dr. Fauci and felt sick about the whole thing. Of course we know where six feet came from! This was not new. As someone who has worked on the ground with state, community and local healthcare leaders to bring awareness to the most vulnerable citizens and debunk conspiracy theories in order to pave the way for people to get vaccinated and protect themselves, hearings like these set us back significantly. It is full time for our nations leaders to start having substantive conversations about how to prepare for the next pandemic, instead of trying to find a scapegoat for the past one.
Thank you for your thoughtful and balanced opinions in this space. You make a difference in a world that sometimes feel like it has gone completely mad.